According to a study published in European Heart Journal–Cardiovascular Pharmacotherapy, painkillers that are traditionally considered harmless by the general public are associated with increased risk of cardiac arrest. The authors Gunnar H Gislason (Copenhagen University Hospital Gentofte, Denmark) and others are now advising to avoid the use of diclofenac and to limit ibuprofen to 1200mg per day.
The current study investigated the link between use of non-steroidal anti-inflammatory drugs (NSAIDs) and cardiac arrest. All patients who had an out-of-hospital cardiac arrest in Denmark between 2001 and 2010 were identified from the nationwide Danish Cardiac Arrest Registry. Data was collected on all redeemed prescriptions for NSAIDs from Danish pharmacies since 1995. These included the non-selective NSAIDs (diclofenac, naproxen, ibuprofen) and COX-2 selective inhibitors (rofecoxib, celecoxib).
A case-time-control design was used to examine the association between NSAID use and cardiac arrest. Each patient served as both case and control in two different time periods, eliminating the confounding effect of chronic comorbidities. Use of NSAIDs during the 30 days before cardiac arrest (case period) was compared to use of NSAIDs during a preceding 30 day period without cardiac arrest (control period).
A total of 28 947 patients had an out-of-hospital cardiac arrest in Denmark during the 10 year period. Of these, 3 376 were treated with an NSAID up to 30 days before the event. Ibuprofen and diclofenac were the most commonly used NSAIDs, making up 51% and 22% of total NSAID use, respectively. Use of any NSAID was associated with a 31% increased risk of cardiac arrest. Diclofenac and ibuprofen were associated with a 50% and 31% increased risk, respectively. Naproxen, celecoxib and rofecoxib were not associated with the occurrence of cardiac arrest, probably due to a low number of events.
Gislason, an European Society of Cardiology press release reports, says: “The findings are a stark reminder that NSAIDs are not harmless. Diclofenac and ibuprofen, both commonly used drugs, were associated with significantly increased risk of cardiac arrest. NSAIDs should be used with caution and for a valid indication. They should probably be avoided in patients with cardiovascular disease or many cardiovascular risk factors.”
He adds: “I don’t think these drugs should be sold in supermarkets or petrol stations where there is no professional advice on how to use them. Over-the-counter NSAIDs should only be available at pharmacies, in limited quantities, and in low doses.”
Furthermore, Gislason advises that patients should not “take more than 1200 mg of ibuprofen per day” and comments: “Diclofenac is the riskiest NSAID and should be avoided by patients with cardiovascular disease and the general population. Safer drugs are available that have similar painkilling effects so there is no reason to use diclofenac.”
He concludes: “The current message being sent to the public about NSAIDs is wrong. If you can buy these drugs in a convenience store then you probably think ‘they must be safe for me’. Our study adds to the evidence about the adverse cardiovascular effects of NSAIDs and confirms that they should be taken seriously, and used only after consulting a healthcare professional.”
